Combination of Baricitinib and Anti-TNF vs. Baricitinib in Patients With Rheumatoid Arthritis: a Randomized Controlled Phase III Trial

Who is this study for? Patients with rheumatoid arthritis
What treatments are being studied? Baricitinib+Adalimumab
Status: Recruiting
Location: See all (36) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

As stated by the European League Against Rheumatism (EULAR) and the Société Française de Rhumatologie (SFR), treatment of patients with rheumatoid arthritis (RA) should target sustained remission or at least low disease activity. However, despite significant advances based on various combinations of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs, RA therapies meet treatment goals only in some patients: * 40 to 50% of patients with early RA, treated with methotrexate (MTX) monotherapy as first-line therapy, * 20 to 30% of patients treated with a combination of MTX and biologic as second-line therapy. * Less than 10% of patients treated with a combination of MTX and another targeted DMARD, such as baricitinib, as third-line therapy. Therefore, new strategies targeted at achieving a higher percentage of remission are needed, that do not require waiting for multiple failed therapies. Combinations of biologics have shown synergistic improvement of symptoms in murine models of RA relative to the improvement observed with either agent alone. However, in RA patients, only five randomised clinical trials (RCTs) have explored the efficacy and safety of combining tumour necrosis factor (TNF) inhibitor with another biologic (anakinra, abatacept, rituximab or bimekizumab). Baricitinib is a selective, reversible and competitive inhibitor of Janus kinases (Jaki). This treatment is efficient in a number of therapeutic scenarios in RA and showed a clinical superiority over adalimumab in one RCT (RA-BEAM study in MTX inadequate responders). Of note, baricitinib inhibits many of the pro-inflammatory cytokines involved in the pathogenesis of RA but does not block signalling downstream of TNF. Owing to the interest in combining different mechanisms of action, the investigators plan to assess the efficacy and safety of combination therapy with baricitinib and a TNF inhibitor. The investigators are aware that combining targeted therapies is not recommended due to a potential increase in the frequency of serious adverse events. However, several case series on patients treated with a combination of targeted therapies have been published, suggesting a certain efficacy in patients with refractory RA. The first ones focused on inflammatory bowel diseases and psoriasis, but more recently, combination of tofacitinib (which belongs to the same Jaki family as baricitinib) with various biologics has been reported in a sample of RA patients. No serious adverse effects were reported over a mean of approximately 11 months of therapy. The clinical improvement was mild but noticeable in these refractory RA cases. Recently, data of interest from the RA-BEAM study have been reported. Patients who switched from adalimumab to baricitinib showed improvements in disease control. Because the switch from adalimumab to baricitinib occurred without a washout period, and because adalimumab has a mean circulating half-life of approximately 14 days, patients would have received several weeks of dual TNF and Jak1/Jak2 inhibition in the course of the change of treatment. The observation of increased efficacy, with no apparent acute safety issues during the weeks when patients were exposed to both adalimumab and baricitinib, is of interest, and supports our strategy to combine the two treatments for patients with refractory RA. The investigators consider that there is a need for investigation into the addition of anti-TNF to baricitinib in patients suffering of refractory RA (inadequate response to TNF inhibitors). The investigators hypothesize that in this population, based on ACR50 score, this combination therapy will decrease disease activity more efficiently than a switch to another targeted DMARD, such as baricitinib.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Maximum Age: 65
Healthy Volunteers: f
View:

• Male or female;

• Age between 18 and 65 years-old;

• Adult patient with a diagnosis of RA as defined by the ACR/EULAR 2010 criteria for the classification of RA;

• Patient who presents an inadequate response to at least one bDMARD or tsDMARD for at least 12 weeks prior to study entry at a dose that is considered acceptable to assess clinical response adequately;

• Patient affected by active RA (DAS28-ESR \> 3.2 or sDAI \> 11 or cDAI \> 10) eligible to receive a bDMARD or tsDMARD according to the French Society of Rheumatology guidelines;

• Patient treated by prednisone dosage ≤ 10mg per day. The corticosteroids dosage will be decreased to 7,5 mg/day at the beginning of the study (W0);

• Person affiliated with or beneficiary of the French social security scheme;

• Free, informed and written consent signed by the participant and the investigator (on the day of inclusion at the latest and before any examination required by the research project).

Locations
Other Locations
France
CH de la Côte Basque - service de rhumatologie
NOT_YET_RECRUITING
Bayonne
CH de Belfort - service de rhumatologie
RECRUITING
Belfort
AP-HP - Hopital Avicenne - service de rhumatologie
NOT_YET_RECRUITING
Bobigny
CHU de Bordeaux - service de rhumatologie
RECRUITING
Bordeaux
CHU de Brest - Service de rhumatologie
RECRUITING
Brest
Clinique de l'Infirmerie - service de rhumatologie
RECRUITING
Caluire-et-cuire
CHU de Clermont-Ferrand - service de rhumatologie
RECRUITING
Clermont-ferrand
CH de Dax - service de rhumatologie
RECRUITING
Dax
CHD VENDEE - service de rhumatologie
RECRUITING
La Roche-sur-yon
AP-HP - Hôpital Kremlin-Bicêtre - service de rhumatologie
RECRUITING
Le Kremlin-bicêtre
CH du Mans - service de rhumatologie
RECRUITING
Le Mans
CH Emile Roux - service rhumatologie
NOT_YET_RECRUITING
Le Puy-en-velay
Polyclinique de Limoges - service de rhumatologie
RECRUITING
Limoges
Groupement des Hôpitaux de l'Institut Catholique de Lille - service de rhumatologie
RECRUITING
Lomme
AP-HM - service de rhumatologie
RECRUITING
Marseille
Hôpital Saint-Joseph - service de rhumatologie
RECRUITING
Marseille
CHU de Montpellier - service de rhumatologie
RECRUITING
Montpellier
CHU de Nice - service de rhumatologie
RECRUITING
Nice
CHU de Nîmes - service de rhumatologie
NOT_YET_RECRUITING
Nîmes
CH de Niort - service de rhumatologie
NOT_YET_RECRUITING
Niort
Nouvel Hôpital Orléans La Source - service de rhumatologie
RECRUITING
Orléans
AP-HP - Hôpital Bichat - service de rhumatologie
RECRUITING
Paris
AP-HP - Hôpital Cochin - service de rhumatologie
RECRUITING
Paris
AP-HP - Hôpital La Pitié-Salpetrière - service de rhumatologie
RECRUITING
Paris
AP-HP - Hôpital Saint-Antoine - service de rhumatologie
NOT_YET_RECRUITING
Paris
CH de Pau - service de rhumatologie
RECRUITING
Pau
Hospices Civils de Lyon - service de rhumatologie
NOT_YET_RECRUITING
Pierre-bénite
Hopital NOVO - service de rhumatologie
NOT_YET_RECRUITING
Pontoise
CH de Reims - service de rhumatologie
RECRUITING
Reims
CHU de Saint-Etienne- service de rhumatologie
RECRUITING
Saint-etienne
CH de Saint-Malo - service de rhumatologie
NOT_YET_RECRUITING
St-malo
CHRU de Strasbourg - service de rhumatologie
RECRUITING
Strasbourg
CHU de Toulouse - service de rhumatologie
RECRUITING
Toulouse
CHRU du Tours - service de rhumtologie
RECRUITING
Tours
CHRU de Nancy - service de rhumatologie
NOT_YET_RECRUITING
Vandœuvre-lès-nancy
Monaco
service de Rhumatologie - CH Princesse Grace
RECRUITING
Monaco
Contact Information
Primary
Christophe RICHEZ, Prof
christophe.richez@chu-bordeaux.fr
05.56.79.55.56
Backup
Thomas BARNETCHE, PhD
thomas.barnetche@chu-bordeaux.fr
Time Frame
Start Date: 2021-07-15
Estimated Completion Date: 2026-12
Participants
Target number of participants: 178
Treatments
Experimental: Period A : baricitinib + anti-TNF
Placebo_comparator: Period A : baricitinib + placebo
Experimental: Period B : baricitinib + anti-TNF
Active_comparator: Period B : baricitinib
Sponsors
Collaborators: Eli Lilly and Company, Ministry for Health and Solidarity, France, Biogen
Leads: University Hospital, Bordeaux

This content was sourced from clinicaltrials.gov